NueSynergy sFTP Request Form

Section A: NueSynergy Client Information

Point of Contact

Phone Number

Email

Employer Name

Employer Contact Name

Employer Phone Number

Employer Email

# of Employees Enrolled

Plans in Scope (check all that apply):

HRA HSA FSA DCA Transit & Parking COBRA

Type of File Feed:

Eligibility Contribution Qualifying Event Initial Notices

Plan Effective Date

Employer Contributions

Require PGP Encryption?

PGP Point of Contact

PGP Contact Phone

PGP Contact Email

Root URL

Folder Path

Username

Password

Additional Notes/Instructions